Using Data to Simplify Medi-Cal Enrollment

A different approach to Medi-Cal eligibility renewal was floated yesterday at an informational seminar in Sacramento.

The idea is to limit the amount of forms and paperwork in renewing Medi-Cal eligibility. That might be accomplished in part by using statistical analysis of eligibility data to determine which beneficiaries don’t need to fill out new forms when their Medi-Cal benefits are up for renewal, said Stan Dorn, senior fellow at the Urban Institute, a Washington, D.C.-based think tank.

“The traditional way to handle Medicaid enrollment is very paperwork-intensive,” Dorn said. “The applicant fills out a piece of paper, supplies immigration documents and pay stubs. Then when eligibility is renewed, there’s a new form mailed to them, and they need current pay stubs and so on. … But now accessing that data and processing it is much cheaper and more reasonable and plausible than it was then.”

That kind of paperwork burden severely limits the number of eligible Californians enrolling, Dorn said.

“It’s not an issue of low-income beneficiaries, or language issues. It’s an issue of human nature,” Dorn said.

He said the numbers bear that out in all phases of society. For example, he said, if people qualify for an IRA, only about 15% of them will actually enroll in one, he said. That number goes up to 33% when an employer presents the same benefits with a single form to fill out. But if that same employer says people have to fill out a form to opt out of the IRA plan, enrollment will jump to 90%.

“Paperwork is powerful in determining enrollment,” he said.

Yesterday’s presentation, “Data Match: Streamlining Eligibility and Enrollment Under the Affordable Care Act,” was sponsored by California HealthCare Foundation, which publishes California Healthline.

Under the Affordable Care Act, Dorn said, renewing Medicaid eligibility (Medi-Cal in California) has to meet the burden of being “reasonably certain” of eligibility status.

That expectation can be met for an overwhelming majority of Medi-Cal recipients, he said, without any paperwork being filled out.

When you look at the numbers, he said, the percentage of people who disqualify from Medi-Cal (those who make too much money to continue qualifying for Medi-Cal benefits) is much higher at the upper limits of Medi-Cal eligibility. So, he said, those people between 120% and 138% of federal poverty level, which is the upper limit of Medi-Cal eligibility, are more likely not to qualify for renewal than the people at, say, 100% of FPL.

At a lower poverty level, the percentage of people who would remain in Medi-Cal would be much higher — in some cases, 80% or 90% of those people qualify for Medi-Cal renewal after one year.

So here’s the idea, Dorn said: If the state sets “reasonably certain” to mean that 80% or even 90% of certainty, then you have a whole strata of lower-income beneficiaries who could automatically qualify for renewal of Medi-Cal benefits.

“The hope is, when consumers have fewer paperwork burdens, more will apply, more will renew,” Dorn said. “Administrative costs will drop, and the hope is you’ll actually have more accurate eligibility numbers and fewer erroneous decisions.”

The paper detailing yesterday’s presentation has not yet been released, but Dorn said that will happen soon. The first part of this two-part discussion —  outlining the creation of an “enrollment superhighway” — is detailed in a policy briefing released last month.

Related Topics

Capitol Desk Medi-Cal